Abstract
BackgroundThe optimal reconstructive method after diaphyseal malignant bone tumor resection remains controversial. This multicenter clinical study was designed to investigate the clinical value and complications of segmental prosthesis in the repair of diaphyseal defects.MethodsWe present 49 patients from three clinical centers treated with wide resection for primary or metastatic bone tumors involving the diaphysis of the femur, tibia, humerus, or ulna, followed by reconstruction using a modular intramedullary segmental prosthesis.ResultsEnrolled patients included 23 men and 26 women with a mean age of 63.3 years. Of these, seven patients had primary bone tumors and 42 patients had metastatic lesions. At the mean follow-up of 13.7 months, 17 patients were alive, 31 patients were deceased due to tumor progression, and one patient was dead of another reason. There were eight nononcologic complications (two with radial nerve injury, three with delayed incision healing, two with aseptic loosening in the proximal humerus prosthetic stem and one with structural failure) and three oncologic complications (three with primary tumor recurrence) among all patients. The incidence of complications in primary tumor patients (4/7, 57.1%) was higher than that in patients with metastatic tumors (7/42, 16.7%) (p = 0.036). Aseptic loosening and mechanical complications were not common for patients with primary tumors, although the reconstruction length difference was statistically significant (p = 0.023). No statistically significant differences were observed in limb function, while the mean musculoskeletal tumor society score was 21.2 in femora, 19.6 in humeri, and 17.8 in tibiae (p = 0.134).ConclusionsSegmental prostheses represent an optional method for the reconstruction of diaphyseal defects in patients with limited life expectancy. Segmental prostheses in the humerus experienced more complications than those used to treat lesions in the femur.
Highlights
The optimal reconstructive method after diaphyseal malignant bone tumor resection remains controversial
Patients We retrospectively studied the medical records of patients treated between 2010 and 2017 at three musculoskeletal oncology centers in China
Inclusion criteria were patients with segmental bone loss from primary malignant or metastatic tumor resection with sparing of the joint, deemed unsuitable for biologic reconstruction, and who were surgically treated with a modular intercalary segmental prosthesis in the diaphysis of the ulna, humerus, tibia, or femur
Summary
The optimal reconstructive method after diaphyseal malignant bone tumor resection remains controversial. This multicenter clinical study was designed to investigate the clinical value and complications of segmental prosthesis in the repair of diaphyseal defects. The reconstruction of diaphyseal defects following malignant tumor resection has long been a challenge. Alternative reconstruction methods include autografts [2, 3], allografts [4, 5], bone transport [6], inactivated bone replantation [7, 8], and segmental prostheses [9,10,11,12]. The advantages of segmental prosthesis reconstruction include early mobilization, simple operation, short hospital stay and the ability to tolerate chemotherapy and radiotherapy after incision healing. Compared to other reconstruction methods, the available literature on segmental prostheses is scarce and the clinical effects of segmental prostheses are not clear
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